P07-03 The characteristics of the medical prescription for adapted physical activity among the French Health System, experience of the Grand Est region

Abstract Issue/problem The law of modernization of the French health system promoted in 2016 have authorized any attending physician to prescribe a program of physical activity suitable for patients with a chronic disease. The health benefits of active living habits are now well known but too few physicians have seized this prescription of Adapted Physical Activity (APA). Description of the problem APA teachers have come to complement the health professions to deliver APA, and sports clubs have improved their organization to welcome patients who have adequate physical condition. Regional systems have been deployed to receive patients, using such resources. The ‘Médicosport Santé’ guide provides relevant guidance for patients according to physical and/or sporting activities (PSA) and diseases. The medical prescription for APA must therefore become a practical reality for chronic disease patients, guaranteeing a lasting change in lifestyle through more active behavior. Experience from the Grand Est country The commitment of certain French Regional Health Agencies, has led certain regions to offer regional systems, as the “Prescri'mouv” plan in the Grand Est country, allowing a step forward to best support the patient from the medical prescription to regular and lasting practice. After medical prescription, patients are directed to an APA professional or physiotherapist, for an initial evaluation and orientation towards one of the three types of care: autonomous practice, labeled structure, specific support. Lessons The main objective of APA is to fight against a sedentary lifestyle. With an adequate physical condition, physical activities and sports are to be considered in order to help patients with chronic disease, sources of pleasure and lasting health benefits. New actors have come to strengthen health professionals, and through ‘Sport Santé’ concept, sports clubs have organized themselves to welcome patients. Main messages Adapted physical activity is the keystone in the fight against sedentary lifestyle. New players have come to strengthen health professionals, sports clubs have organized themselves to welcome of and best support patients with chronic disease. The challenge is for physicians to take hold of this medical prescription for APA, by directing patients towards more active lifestyle habits.


Issue/problem
The law of modernization of the French health system promoted in 2016 have authorized any attending physician to prescribe a program of physical activity suitable for patients with a chronic disease. The health benefits of active living habits are now well known but too few physicians have seized this prescription of Adapted Physical Activity (APA). Description of the problem APA teachers have come to complement the health professions to deliver APA, and sports clubs have improved their organization to welcome patients who have adequate physical condition. Regional systems have been deployed to receive patients, using such resources. The 'Médicosport Santé' guide provides relevant guidance for patients according to physical and/or sporting activities (PSA) and diseases. The medical prescription for APA must therefore become a practical reality for chronic disease patients, guaranteeing a lasting change in lifestyle through more active behavior. Experience from the Grand Est country The commitment of certain French Regional Health Agencies, has led certain regions to offer regional systems, as the ''Prescri'mouv'' plan in the Grand Est country, allowing a step forward to best support the patient from the medical prescription to regular and lasting practice. After medical prescription, patients are directed to an APA professional or physiotherapist, for an initial evaluation and orientation towards one of the three types of care: autonomous practice, labeled structure, specific support.

Lessons
The main objective of APA is to fight against a sedentary lifestyle. With an adequate physical condition, physical activities and sports are to be considered in order to help patients with chronic disease, sources of pleasure and lasting health benefits. New actors have come to strengthen health professionals, and through 'Sport Santé' concept, sports clubs have organized themselves to welcome patients.

Main messages
Adapted physical activity is the keystone in the fight against sedentary lifestyle. New players have come to strengthen health professionals, sports clubs have organized themselves to welcome of and best support patients with chronic disease. The challenge is for physicians to take hold of this medical prescription for APA, by directing patients towards more active lifestyle habits.

Background
With the first initiatives dating back to the 1990s, the past two decades have seen a rapid increase in the use of exercise referral schemes (ERS) worldwide. Despite the accumulating evidence on their effectiveness, there are currently no international guidelines available to inform the design of such interventions.
The key elements and processes employed vary both within and between countries. This systematic review aims to address this frequently overlooked topic by identifying elements that are predominant in international ERS. Methods Scientific databases (PubMed, Scopus) and grey literature sources were systematically searched. In order to collect the information relevant for understanding and visualizing all ERS models, a broad spectrum of document types was considered eligible for inclusion, i.e. randomized controlled or pragmatic trials, cohort studies, case-control studies, case series, case reports, qualitative studies, economic evaluations, mixed designs, policy documents, and official governmental reports. We extracted data on scheme components, contents, and main actors involved in scheme delivery. Cross-functional flowcharts were employed to facilitate comparison between different ERS designs: Firstly, the collected data were visualized in flowcharts indicating the pathway a patient follows from beginning to end of an individual ERS. Secondly, elements that appeared more frequently across all included ERS were identified.

Results
Preliminary results identified 18 models of ERS that were eligible for data analysis, including Green Prescription (New Zealand), Hreyfiseôill (Iceland), National Exercise Referral Scheme (Wales). Program designs ranged from short advice by a primary healthcare professional to physical activity prescription and/or further referral to affiliated health professionals. The prevailing actors involved in scheme delivery were physicians, nurses, physiotherapists, training experts, physical activity providers, and coordinators. Seven predominant elements emerged from the comparison between ERS designs: assessment, counselling, individualized physical activity recommendations, written prescription, behavior change techniques, support person, and follow-up.

Conclusions
To the best of our knowledge, this is the first study that takes a closer look at the design characteristics of ERS across the world. Our preliminary results indicate that there are seven key elements. The contribution of these elements on the effectiveness of ERS needs to be explored in future research.